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Organization
PORT ALLEN CARE CENTER, LLC
Active
Organization
PORT ALLEN CARE CENTER, LLC
Active
Other names
Legacy Nursing and Rehabilitation of Port Allen
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR D GUM (MANAGER)
(225) 800-4955
Entity
Organization
Contact information
Practice address
403 N 15TH ST, PORT ALLEN, LA 70767-2264
(225) 346-8815
(225) 346-8989
Mailing address
403 N 15TH ST, PORT ALLEN, LA 70767-2264
(225) 346-8815
(225) 346-8989
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
385
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520039
—
LA
Enumeration date
09/22/2006
Last updated
04/29/2019
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